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Example: <br />Chocolate Chip Cookies with Walnuts <br />and folic acid), bitter (mik, salt), chocolate chips (sugar, chocolate liquor, oocoa butter, butterfat <br />Note: For the ‘Issued in County" - Identify the jurisdiction (city/county) where you are obtaining approval. <br />6. Disposal of Waste: <br />7. Water Source: <br />4 CFO REG/PERMITTfiG FORMI •<) 14 27 6.28.2023 <br />In the event of septic system failure or plumbing problem, you are required to notify San Joaquin County Environmental Health <br />Department immediately. <br />Please check what type of treatment is used to dispose of waste <br />Public Sewer Service Private Septic System <br />Made in a home kitchen <br />Net Wt 3 oz. (85.05g) <br />BIG CAKE BAKER <br />Stockton CA 95209 <br />Perm itW 012345 <br />Issued in: San Joaquin County <br />Pease Identify the water source to be used in Cottage Food Facility (check one box) <br />[J] Name of Public Water System or Community Services District: <br />O Private Water Supply**, Identify the source (well, spring, surface, etc.): <br />Private Water Supply. Initial Water Quality Results <br />Check boxes below if initial water testing has been completed. <br />All testing must be done at a State Certified Laboratory. Either attach lab results or provide name of lab, date & <br />results in space provided next to type of test. <br />•(Testing frequency for transient Non-Community Water Systems after initial testing) <br /> Bactenological Test (quarterly*): <br /> Nitrate Test (yearly*): <br />i <br />I <br />I <br />I Ingrediencx Enriched fbir (wheat flour, niadn, reduced iron, thiamine, mononitrate, riboflavin <br />* —— >4 ___t-4l ft- . —_____i • ■ ■-» • . .. a <br />I (m»k), walnuts, a<ar, eggs, salt, artificial van ilia extract, bakirg soda <br />i Contains: Wheat, milk, eggs, soy, walnuts